DNP versus MD?

[Therapist4Chnge]

18 months.....wow. Okay, time to go check out those threads.

-t

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[core0]

Thanks, I did a quick search and found this thread.

http://forums.studentdoctor.net/showthread.php?t=471736

I read the RN/NP/PA forums because my wife is in PA school and I like to keep myself somewhat updated on the professional climate. I don't normally read the Physician/Residency forums and I hadn't seen this info pop un here where there always tends to be a lot of interesting (although heated) discussions on similar topics.

Also one in the surgical forums:
http://forums.studentdoctor.net/showthread.php?t=472082

It really isn't heated in the PA community. There are a lot of PAs that oppose it, but its not particularly controversial. Nova has been doing a Doctorate in Health Sciences for at least five years this is just the first one that has PA attached to it. There is some discussion about it on the PA forum. There is a better article here:
http://physician-assistant.advanceweb.com/Editorial/Content/Editorial.aspx?CC=102696 and there is one in the latest AAPA news.

David Carpenter, PA-C

 

[orbitaloverlap]

I believe that a complete understanding of medical science must start at the basic entry level. The pre-medical requirements are on a much higher level of difficulty, much more demanding and are much more thorough and complete.

I remember helping a pre-nursing student with her watered down single-semester organic chemistry course and she could not believe me when I was explaining to her that H-OH is, in fact, a water molecule. This is of course not representational of all pre-nursing students, and it would be an ad-hominem atack if it were but, it is certainly a local example of the difference in the level of training and mind I say, not the difference in intelligence.

Call me an individualist / Rand-ian thinker, but my committment to science and my passion for understanding medicine is very hard work. My long sleepless nights, and my tireless days of racking my brain in courses where students drop like flies. This is my hard work- and I intend to take full advantage of what will hopefully be a prosperous career in medicine as a physician.

For a person to attempt to assume my role in the field of medicine, they should have at least gone through the same grueling science classes in their college years. Albeit that some pre-medical students may have had a different college experience than I; I have sacrificed a social life, a good part of my health that I must work to get myself back into pre-college shape, and my now tempered nerves to get to where I intend to be.

A nurse, who has an undeniably important role in medicine, must admit their knowledge and depth of understanding of science does not come close to the physician's. This is the academic agreement between these two professionals. It is in NO WAY demeaning for the nurse, and in no way dignifying for the doctor. Both, have signed up for their own careers individually with an understanding of what is required of them in the field of medicine.

So, for the nursing organizations of America to conjure up the DNP degree is a severe blow to the individual rights of the doctor and a severe blow to the potential quality of care patients will recieve. You cannot replace years of pain-staking work with three simple letters.

 

[zenman]

I believe that a complete understanding of medical science must start at the basic entry level.

Does a complete understanding ever occur?

I remember helping a pre-nursing student with her watered down single-semester organic chemistry course and she could not believe me when I was explaining to her that H-OH is, in fact, a water molecule.

Don't most students learn this about the middle school level?

This is of course not representational of all pre-nursing students, and it would be an ad-hominem atack if it were but, it is certainly a local example of the difference in the level of training and mind I say, not the difference in intelligence.

It might be more appropriate to say there is a difference in "information," not necessarily in "intelligence."

 

[mig26x]

I would never hire a PA or NP only because they want to be doctors, then go to medical school!!

 

[derhoy1]

I would never hire a PA or NP only because they want to be doctors, then go to medical school!!

Wow. What a stunningly ignorant thing to say! Midlevel practictioners (in general) do not WANT to be doctors. The midlevel practictioners wanted to be just that - midlevels. Believe it or not, not everyone wants to be a doctor.

So - good plan. Don't hire one. But, be prepared to work with them in some capacity. Just because you won't be the one signing their paycheck doesn't mean they will not be taking care of your patients in some capacity (ie...providing care in an ER, serving as a specialty consultant, or perhaps doing your patient's ultrasound-guided therapeutic thoracentesis).

The vast majority of midlevels understand their role in medicine as a vital part of the healthcare team. Best of luck to you in the future.

 

[mig26x]

Wow. What a stunningly ignorant thing to say! Midlevel practictioners (in general) do not WANT to be doctors. The midlevel practictioners wanted to be just that - midlevels. Believe it or not, not everyone wants to be a doctor.

So - good plan. Don't hire one. But, be prepared to work with them in some capacity. Just because you won't be the one signing their paycheck doesn't mean they will not be taking care of your patients in some capacity (ie...providing care in an ER, serving as a specialty consultant, or perhaps doing your patient's ultrasound-guided therapeutic thoracentesis).

The vast majority of midlevels understand their role in medicine as a vital part of the healthcare team. Best of luck to you in the future.

they dont want to be doctors but everyday they are fighting for more independece to take care of patients on their own!! Take a look at the different forums in here and other websites.

 

[PICUfellow]

If you took all the nurses off the inpatient floor (or clinic or OR or ER or wherever else you work), the place could still run with just doctors. All you need is to get first-year residents and teach them to assist you....

On the other hand, if you took all the doctors out of the place, there would be no hospital.....Regardless of how much practical stuff the nurses have to offer, you guys have to understand that it is the basic medical sciences which are taught in the 1st two years of medical school that still govern all of the medical decisions we make on a daily.....

Good luck trying to care for patients with only practical skills....and I mean good luck to the patients.

 

[Coastie]

Socialists love bringing up midlevels and bringing down doctors to prepare us for socialized medicine. Gotta love people who try to gain something, not by earning it, but by legislating, stealing, etc.

Don't worry nurses of lilliput. You may be putting strings on the giant AMA now, but we'll eventually wake up before it's too late and put an end to these attempts by you and other midlevels to take our place.

they dont want to be doctors but everyday they are fighting for more independece to take care of patients on their own!! Take a look at the different forums in here and other websites.

 

[Tired]

Don't worry nurses of lilliput. You may be putting strings on the giant AMA now, but we'll eventually wake up before it's too late and put an end to these attempts by you and other midlevels to take our place.

Unlikely. The generation of physicians that are in charge now are the exact same ones responsible for the rise of mid-level independence in the first place.

We talk about this issue as though it is some that was done to us, but really it is something we have done to ourselves. Docs don't want to get called at night, or deal with the responsibility of teaching residents, or see all their own patients in clinic, so we expand the use and scope of mid-level practitioners. They are perpetual residents who do all the dirty work for a decent salary, and in turn physicians grant them autonomy to act in their name.

You think the AMA is going to "wake up"? I've got news for you, they already did. They realized that they can make a ton of money off the mid-levels, at the expense of the younger physicians coming up behind them.

 

[Coastie]

Then we'll need to take things in our own hands. Don't think surgeons, such as yourself, will be immune to the tides of change from all sides, including mid-levels..

Unlikely. The generation of physicians that are in charge now are the exact same ones responsible for the rise of mid-level independence in the first place.

We talk about this issue as though it is some that was done to us, but really it is something we have done to ourselves. Docs don't want to get called at night, or deal with the responsibility of teaching residents, or see all their own patients in clinic, so we expand the use and scope of mid-level practitioners. They are perpetual residents who do all the dirty work for a decent salary, and in turn physicians grant them autonomy to act in their name.

You think the AMA is going to "wake up"? I've got news for you, they already did. They realized that they can make a ton of money off the mid-levels, at the expense of the younger physicians coming up behind them.

 

[princekc]

I would never hire a PA or NP only because they want to be doctors, then go to medical school!!

you're absolutely wrong...bias aside...misconception aside..just give it a try and work with a midlevel preferably a PA and you'll be happy indeed...

 

[Tired]

you're absolutely wrong...bias aside...misconception aside..just give it a try and work with a midlevel preferably a PA and you'll be happy indeed...

Of course they're great people, smart, hardworking, generally fun to work with.

The issue isn't personality, it's politics and business. The mid-level movement has, in many arenas, begun pushing for greater independent practice. That means less business for us. Maybe it has no impact on patient care. Maybe it puts them at risk. But regardless, it is cash out of our pockets.

 

[mig26x]

Of course they're great people, smart, hardworking, generally fun to work with.

The issue isn't personality, it's politics and business. The mid-level movement has, in many arenas, begun pushing for greater independent practice. That means less business for us. Maybe it has no impact on patient care. Maybe it puts them at risk. But regardless, it is cash out of our pockets.

exactly, I dont have anything agaisnt RN and PA who accept their roles in medicine and dont want to fight for independence. My problem is with PA's that are actively fighting to have 100% freedom from M.D's. Again, if you want to do the same as an MD go to med school, is that easy.

 

[core0]

exactly, I dont have anything agaisnt RN and PA who accept their roles in medicine and dont want to fight for independence. My problem is with PA's that are actively fighting to have 100% freedom from M.D's. Again, if you want to do the same as an MD go to med school, is that easy.

Would you please show one single quote from anyone in an official position that advocates independence for PAs. The PA profession is by nature a dependent practice.

David Carpenter, PA-C

 

[zenman]

If you took all the nurses off the inpatient floor (or clinic or OR or ER or wherever else you work), the place could still run with just doctors. All you need is to get first-year residents and teach them to assist you....

On the other hand, if you took all the doctors out of the place, there would be no hospital.....Regardless of how much practical stuff the nurses have to offer, you guys have to understand that it is the basic medical sciences which are taught in the 1st two years of medical school that still govern all of the medical decisions we make on a daily.....

Good luck trying to care for patients with only practical skills....and I mean good luck to the patients.

Totally wrong...which you would know if you studied anything other than medicine. Hospitals exist for nursing care. Just for an example, the FP I work with said she didn't know how to do anything but write orders for nurses to carry out. I recently taught her to help me give flu shots.

Also, if I remember correctly, many years ago, the death rate dropped when doctors in NY went on strike.

 

[kylek044]

Totally wrong...which you would know if you studied anything other than medicine. Hospitals exist for nursing care. Just for an example, the FP I work with said she didn't know how to do anything but write orders for nurses to carry out. I recently taught her to help me give flu shots.

Sounds like a bit (read: total) exaggeration.

 

[Tired]

Totally wrong...which you would know if you studied anything other than medicine. Hospitals exist for nursing care. Just for an example, the FP I work with said she didn't know how to do anything but write orders for nurses to carry out. I recently taught her to help me give flu shots.

Also, if I remember correctly, many years ago, the death rate dropped when doctors in NY went on strike.

Um . . . you're not even in health care, right?

 

[PICUfellow]

Totally wrong...which you would know if you studied anything other than medicine. Hospitals exist for nursing care. Just for an example, the FP I work with said she didn't know how to do anything but write orders for nurses to carry out. I recently taught her to help me give flu shots.

Also, if I remember correctly, many years ago, the death rate dropped when doctors in NY went on strike.

LOL, you're funny......I hope you know that that FP was just saying that to make you feel better i.e. boost your ego? I do it all the time to the nurses. Giving a flu shot is hardly a specialized skill, my dear.

As to the statement that hospitals exist for nursing care? I'll just laugh at that one, cause I dont suppose you expect a serious reply to that...

 

[zenman]

LOL, you're funny......I hope you know that that FP was just saying that to make you feel better i.e. boost your ego? I do it all the time to the nurses. Giving a flu shot is hardly a specialized skill, my dear.

As to the statement that hospitals exist for nursing care? I'll just laugh at that one, cause I dont suppose you expect a serious reply to that...

Giving a flu shot is hardly any skill...which shows what is coming out of at least one medical school these days. She said they were not taught many technical skills since there were other people (nurses) to do them.

Go talk to your hospital administrator to get the latest info.

And you might not want to call me "my dear" to my face because you'll be looking at a 6' 3" 220 pound male nurse who can rip every joint in your body apart.

Health care is teamwork but until you stay at the bedside ...and actually touch a patient..for more than a few moments, then you will become enlightened.

 

[kylek044]

She said they were not taught many technical skills since there were other people (nurses) to do them.

So what are you proposing that medical students learn in their four additional years of training in medical school, and then their residencies as physicians? In 12+ years, they just skip-over the things you learned in nursing school? They don't get that "technical?"
And for the record, you were talking about nursing-care based institutions... we call them "nursing homes" - I wonder how they got that name. Physicians who are hospitalists work at "hospitals." Words are fun.

 

[PICUfellow]

I will repeat that giving a flu shot is not a specialized skill. Congratulations on being able to do it - but anybody can learn that in about,.... er.... 5 minutes.

Knowing which muscle you're injecting, what nerves to avoid, what side effects to look for, and indeed, knowing exactly what the flu vaccine is - on the other hand, might take you longer to learn.......(my dear!).....As well as knowing what patients can get what type of flu vaccine and why, and whether they need to come back for a second vaccine, and why. Notice that I keep saying "and why." Because that is the main difference between doctors and midlevels/nurses. We know "why" things are done. Not just how to do them. There is a science behind the motions.

So when that one unusual case comes along, we might re-think before we follow our routine. And this would be my biggest fear if NPs were allowed to see patients on their own just by following learned routines....

P.S. obesity is nothing to be proud of

 

[foreverLaur]

Knowing which muscle you're injecting, what nerves to avoid, what side effects to look for, and indeed, knowing exactly what the flu vaccine is - on the other hand, might take you longer to learn.......(my dear!).....As well as knowing what patients can get what type of flu vaccine and why, and whether they need to come back for a second vaccine, and why. Notice that I keep saying "and why." Because that is the main difference between doctors and midlevels/nurses. We know "why" things are done. Not just how to do them. There is a science behind the motions.

So when that one unusual case comes along, we might re-think before we follow our routine. And this would be my biggest fear if NPs were allowed to see patients on their own just by following learned routines....

So you are saying that mid-level providers do things without knowing why they are doing them? I hate to break it to you, but that is definitely not true. I have met many very intelligent mid-level providers who could fully explain the 'whys' to me.

Your statement was way to general in stating that mid-level providers do not know why they do the things they do. I don't think there are very many (if any) nurse practitioners and physician assistants running around who have no idea why they do the things they do if someone goes into v-fib, for example.

 

[kylek044]

So you are saying that mid-level providers do things without knowing why they are doing them? I hate to break it to you, but that is definitely not true. I have met many very intelligent mid-level providers who could fully explain the 'whys' to me.

Your statement was way to general in stating that mid-level providers do not know why they do the things they do. I don't think there are very many (if any) nurse practitioners and physician assistants running around who have no idea why they do the things they do if someone goes into v-fib, for example.

I think you took that the wrong way. There is a surface "why" and a deeper "why." The deeper "why" is the complete explanation that includes having a diagnosis and understanding the variety of treatments (either surgical or medicinal, etc.) For example, a physician can pick up a EKG and interpret the electrical activity to diagnose the condition and knows that a certain treatment would be appropriate for the condition because of the electrical activity. This deeper level may be learned through experience, but it is definitely taught at medical schools. It is simply not taught in BSN or nursing certificate programs - it is also not the scope of practice of RNs and other midlevels (NPs and PAs must be supervised to do this). That's all the poster was saying.

 

[foreverLaur]

It can be in the scope of practice for many PAs. PAs can run solo in the ED at times or at another ED a MD/DO does the same thing as a PA. Granted, PAs gain this status by experience vs residency. A PA is very well versed in his/her specific field, but may not know as much about medicine in general as a MD/DO would.

 

[Jawbone]

If you took all the nurses off the inpatient floor (or clinic or OR or ER or wherever else you work), the place could still run with just doctors. All you need is to get first-year residents and teach them to assist you....

On the other hand, if you took all the doctors out of the place, there would be no hospital.....Regardless of how much practical stuff the nurses have to offer, you guys have to understand that it is the basic medical sciences which are taught in the 1st two years of medical school that still govern all of the medical decisions we make on a daily.....

Good luck trying to care for patients with only practical skills....and I mean good luck to the patients.

Good luck taking all the nurses off the floor, and finding the time and manpower to care for 300-400+ patients, all who need individualized teaching, regular assessments, multiple medications, IVs and tests. Add in personal care, dealing with families, coordinating care, ventilator care, ambulating your patient, etc all done with a bunch of 1st year residents. Who do you think calls the residents/fellows when their assessment determines that they need a medical decision made for their patient? You're not the only ones that have to make decisions. This is where book knowledge and real world knowledge collide. 15 minute assessment/visits won't cut it like it does as a doctor. You'll find you're spending more than the requisite 10 minutes it seems to take you to see, "assess" and write orders for one patient. Instead, you'll spend 12 hours on your feet with barely a break to eat or pee. You can't be so naive to believe that nursing care in the hospital setting can be replaced by physicians. This must be while I get 10-12 job offers a month in the mail for my nursing "services."

Again, there is a place for midlevels in the healthcare field, and it's time that the members on this board agree on that. Enough hateful posts and mudslinging. I'm surprised that the mods here allow all the personal attacks I've seen so far on this thread.

 

[kylek044]

It can be in the scope of practice for many PAs. PAs can run solo in the ED at times or at another ED a MD/DO does the same thing as a PA. Granted, PAs gain this status by experience vs residency. A PA is very well versed in his/her specific field, but may not know as much about medicine in general as a MD/DO would.

Technically, the PA still needs to be "supervised" in some way - whether that is the monthly review that is required in Alabama, or the weekly meeting required in Arizona, Missouri's policy that the MD/DO be physically present for 66% of the time, or the "continuous telecommunication" supervision required in many states. Each state has it's own policies, but all states require some level of supervision.
Obviously, some autonomy is earned by the PA when the physician sees fit - although this is not necessarily by-the-books.

 

[chimichanga]

If you took all the nurses off the inpatient floor (or clinic or OR or ER or wherever else you work), the place could still run with just doctors. All you need is to get first-year residents and teach them to assist you.....

But then guys like doc 02 and gasnewby couldn't nurse bash...

oh wait, they were banned...

troll

 

[PICUfellow]

Instead, you'll spend 12 hours on your feet with barely a break to eat or pee.

I really was not going to respond on this thread anymore. But then I saw this line and I was like: OH NO YOU DIDNT!!!

Try spending 30 hours on your feet with barely a break to eat or pee, which is what I do on my calls, which by the way are Q4. I've done this since 1st year of residency. You work 12 hrs with the day-shift nurses, then the night nurses come on. Then they leave and you see the day nurses from yesterday back again. And they're looking all fresh and revived, but you havent had a shower and you haven't slept. And yet you still cant leave at 7am. You work till noon and then you leave. And if you're in a busy hospital like mine, that is constant work, being on your feet running from room to room.

But that's not what this thread is about. I love my job. I absolutely LOVE my job. And this thread seems to be going in different directions. So I wont reply anymore unless it's talking about the issue at hand...And regarding the issue at hand, I wont deny that nurses are great. That we need nurses. And that there is a role for NPs and PAs. All I'm saying (and I think 90% of people would agree - even though I didnt carry out the survey) - is that their role can never be that of the doctors. And we owe it to the patients who are waiting to see a doctor, to give them a doctor. And that if the NPs want independence then they need to go to medical school. Uh oh...have I said too much??

 

[Tired]

So you are saying that mid-level providers do things without knowing why they are doing them? I hate to break it to you, but that is definitely not true. I have met many very intelligent mid-level providers who could fully explain the 'whys' to me.

Just because they can explain the "why" in ways that impress a pre-med, does not mean that they are doing it with a fully educated understanding. If you get into medical school, you will realize about midway through your 3rd year that, while your technical skills are inferior to theirs, your knowledge base is already better.

 

[Tired]

Try spending 30 hours on your feet with barely a break to eat or pee, which is what I do on my calls, which by the way are Q4. I've done this since 1st year of residency. You work 12 hrs with the day-shift nurses, then the night nurses come on. Then they leave and you see the day nurses from yesterday back again. And they're looking all fresh and revived, but you havent had a shower and you haven't slept. And yet you still cant leave at 7am. You work till noon and then you leave. And if you're in a busy hospital like mine, that is constant work, being on your feet running from room to room.

Yeah, basically we work their entire week in one day.

 

[All4MyDaughter]

The mud-slinging in this thread is out of control.

Nurses and physicians play different, but crucial roles in health care delivery. I've seen it myself from three sides: as a patient, as a hospital employee and as a rotation student. The hospital could not function without EITHER group.

The purpose of this forum is for clinicians such as nurses, RTs, etc to discuss transitioning into doctoral-level health care careers. Some deviation from that line of discussion is fine but the bashing of other professions is not.

Consider this everyone's official warning on the subject.

 

[zenman]

So what are you proposing that medical students learn in their four additional years of training in medical school, and then their residencies as physicians? In 12+ years, they just skip-over the things you learned in nursing school? They don't get that "technical?"

And for the record, you were talking about nursing-care based institutions... we call them "nursing homes" - I wonder how they got that name. Physicians who are hospitalists work at "hospitals." Words are fun.

I really don't care what they learn or don't learn. I was merely challenging PICU fellow and his thinking about taking nurses off the floor and letting residents run the place.

And I'm talking about acute care hospitals, not nursing homes. Yes, you have to have all members of the team, but as a nurse with 35 years experience (and one admin position reporting directly to the hospital CEO), I can tell you that hospitals are there to provide 24/7 nursing care. The hospitalists at the last hospital I worked at were not in the ICU 24 hrs. During the night there was one ED doc and a surgical resident, including one who thought he could park his vehicle in the chief of surgery's spot and wondered why his car disappeared. Luckily, I also had the technical skills to get into the surgery suite when he left his pager in there and couldn't get back into the locked door.

I guess you also don't want to hear about the vent patients I used to have at home...and no MD present around the clock.

But yes, I agree it takes a team, but remember there is a difference in barking out orders vs making sure the work gets done...all the while trying to make physicians, patients, family members and admin happy.

 

[zenman]

Just because they can explain the "why" in ways that impress a pre-med, does not mean that they are doing it with a fully educated understanding. If you get into medical school, you will realize about midway through your 3rd year that, while your technical skills are inferior to theirs, your knowledge base is already better.

The knowledge base of a physician should be more that that of a nurse of midlevel practitioner. However, working as a team serves better to CYA. The FP I work with certainly has more knowledge but I have more experience in some areas and have seen more than she has. Our "togetherness" comes in handy when I catch that "deer in the headlight" look in her eyes and I'm able to come up with a suggestion. Even though we have both torn though Guyton's textbook, I do not want the final responsibility that she has and I will admit that in a minute.

In my career, I've had physicians cover my butt and I've done the same with them. I've even had the gall to "accidently" add on additional lab work...and had the physician call me at home to thank me as the results altered his treatment plan. And that's the way it should be, sonny boys.

 

[smq123]

Instead, you'll spend 12 hours on your feet with barely a break to eat or pee.

I don't know how to break this to you - but this totally describes my surgery and ob/gyn rotation. And I'm only a third year med student.

Not to mention the fact that this often described a post-call day for me.

I know nurses work hard. But trying to make it sound like their hours are worse or more demanding than a resident's hours is...well...a little naive.

 

[deleted6669]

for what it's worth I often do 16 hr shifts.
sometimes they are incredibly busy, sometimes less so.
I see every pt who comes in the door. treat and discharge those I can and transfer those who need a higher level of care. I am scheduled interchangeably with the doc group on these night shifts. an md reviews my charts within 12-24 hrs of the end of the shift as required by hospital policy. the state requires only "an ongoing assessment" without a specific chart review % but the hospital says they get better reimbursement and malpractice rates if every chart is reviewed. my sponsoring physician actually asked the hospital if he could stop reviewing charts given the state laws and they gave him the above reasoning for continuing to review them.

 

[DocNusum]

I don't know how to break this to you - but this totally describes my surgery and ob/gyn rotation. And I'm only a third year med student.

Not to mention the fact that this often described a post-call day for me.

I know nurses work hard. But trying to make it sound like their hours are worse or more demanding than a resident's hours is...well...a little naive.

Yes... YOU are "naive" and THIS is "short-sighted"...
YOU the "third year med student" don't have a ACTUAL license...!!!
You're STILL a "protected" STUDENT...!!!

YOU are not "licensed," nor do YOU carry the responsibility/liability of those (RN/PA-C/NP/MD/DOs) who are licensed.

If YOU decided to Quit Med School tomorrow... and become a computer engineer...
Those LICENSED (RN/PA-C/NP/MD/DOs) personnel would still be there "taking care" of patients...

Think health care "team"...!!!!

YOU probably have NEVER had to sit on/with 2-18 patients and ensure that they get their "physician prescribed" meds & treatments (CC/SICU/MICU/NH RNs)...

You probably have never walked into a CCU room... right after a patient did the "Houdini" (somehow got out of 4 point restraints)... then snatched out their balloon pump and died...

YOU are a "sheltered" med student... (the game IS different)

YOU don't have to figure out how to get "Wanda" (the patient in bed #3 with several concomitant psychosis) to drink that 3 gallons of Golytely...

You just "order it" and walk away... You don't have to clean up the mess...

Dude/dudette...

Step off YOUR horse...

 

[dr aaron]

I do not frequent these threads much, but having come across this one i had to post........the fact is, nurses are VERY crucial to any healthcare setting, that being said they ARE NOT doctors, they do not have the knowledge base of a doctor, and will never be on an "equal level" in terms of knowledge of a physician no matter what some idiot telling these students in a DNP program says......I dare anyone to tell me that a DNP or NP for that matter would pass the USMLE step 1, it wouldnt happen.........nurses are very vital to healthcare, but if they want to do what a doctor does then they need to go back and go to a medical school (U.S., Caribbean, Europe-wherever)......I for one will always send my family to a PHYSICIAN for treatment, not a nurse-whatever title they claim

 

[foreverLaur]

I wonder how PAs would fare in Step 1 since they are taught the medical model. They would obviously have to study a lot more than a medical student, but just a thought.

Anyone have a clue why dermatologists are rather... don't seem to care about healing their patients? Maybe this is just my general area. We have taken my sister to the only three derms within an hour of my parents house and they all just suggest she purchase products from their botiques and have never actually fixed her acne problem. They are quick, rude, and don't seem to care. Two days ago, the derm was running behind and we were asked if we'd rather see her PA. We said that was fine. She was extremely kind, took her time, explained everything (unlike the derm) and prescribed her a medication that is working quite well.

I'm not quite sure why all derms (at least in my area) seem incapable of doing nothing but prescribing meds from their little shops ($$$). Is it that hard to write a prescription? She also continually claims my sister suffers from rosacia even though that is obviously not true. The other derms actually snickered when we told them that.

This is why I think mid-levels are crucial to health care. The doctors see such a high volume of patients and it is so nice to have someone else to sit down and spend time iwth the patients and explain the details to them. In their respective specialties, NPs and PAs are extremely knowledgeable. However, they lack the general (but in-depth) medical knowledge that physicians possess.

Just my two cents from my experiences lately with my sister and the derms.

 

[smq123]

Yes... YOU are "naive" and THIS is "short-sighted"...
YOU the "third year med student" don't have a ACTUAL license...!!!
You're STILL a "protected" STUDENT...!!!

YOU are not "licensed," nor do YOU carry the responsibility/liability of those (RN/PA-C/NP/MD/DOs) who are licensed.

If YOU decided to Quit Med School tomorrow... and become a computer engineer...
Those LICENSED (RN/PA-C/NP/MD/DOs) personnel would still be there "taking care" of patients...

Think health care "team"...!!!!

YOU probably have NEVER had to sit on/with 2-18 patients and ensure that they get their "physician prescribed" meds & treatments (CC/SICU/MICU/NH RNs)...

You probably have never walked into a CCU room... right after a patient did the "Houdini" (somehow got out of 4 point restraints)... then snatched out their balloon pump and died...

YOU are a "sheltered" med student... (the game IS different)

YOU don't have to figure out how to get "Wanda" (the patient in bed #3 with several concomitant psychosis) to drink that 3 gallons of Golytely...

You just "order it" and walk away... You don't have to clean up the mess...

Dude/dudette...

Step off YOUR horse...

Good Lord - did they not require adequate "reading comprehension" skills for PA/DNP school? Jesus.

The point was that if you think that saying "we work 12 hours without a pee break" indicates how hard it is to be a PA/nurse/DNP - if a lowly third year med student works those hours and those conditions, then it's not that spectacular.

Geez. Read people's posts FIRST, figure out what they're saying, THEN go off on weird tirades.

 

[foreverLaur]

I think the point should be that people who work in health care all work extremely hard, can work very long hard hours, and put in a lot of time into difficult work whether your are a med student, doctor, nurse, PA, etc. Nobody really has it "easy."

 

[oldManDO2009]

As a nurse for way to long and a 3rd year medical student I will give my 2 cents...

I have learned so much in medical school and no amount of nursing school training or experience will match what I have learned (sorry zenman). I have great technical skills that allows me to feel much more comfortable with procedures but I did not poses the science background to understand the physiology and pathology that I have acquired in medical school and allows me to make decisions.

Do NP/PA have this kind of training - yes - but not the depth that I have undertaken in the last 3 years.

As a nurse who still works Saturdays to pay my way through med school I have a great respect for nurses and mid-levels and would find another hospital if all the nurses or doctors were removed from the floor...healthcare requires team work and respect.

That said, I will fight tooth and nail to ensure NPs do not expand their scope of practice under this felonious DNP scope expansion. The curriculum will not be the equivalent of medical school no matter how many times they say it!

I have worked with mid-levels (mostly PAs) and have no problem with the service and level of care they provide. I myself have seen an NP and received excellent care and she conferred with her collaborating physician and the model worked well. I do not understand why there is such a push for independent practice rights? I wish an NP could explain why there is such a fanatic push for this type of practice...

 

[Faebinder]

Totally wrong...which you would know if you studied anything other than medicine. Hospitals exist for nursing care. Just for an example, the FP I work with said she didn't know how to do anything but write orders for nurses to carry out. I recently taught her to help me give flu shots.

Also, if I remember correctly, many years ago, the death rate dropped when doctors in NY went on strike.

Dude... think about what you just said... this person had to do enough central lines to graduate from her/his residency... Doesn't know how to give a flu shot? Ya, right.. understand the difference between humor and reality.

 

[JRJ26]

So you are saying that mid-level providers do things without knowing why they are doing them? I hate to break it to you, but that is definitely not true. I have met many very intelligent mid-level providers who could fully explain the 'whys' to me.

Your statement was way to general in stating that mid-level providers do not know why they do the things they do. I don't think there are very many (if any) nurse practitioners and physician assistants running around who have no idea why they do the things they do if someone goes into v-fib, for example.

I don't think thats what he was really saying. I'm pre-med, and my major includes all nursing basic science courses (anat/phys, patho, pharm, microbio). From what I've experienced, and from what I've heard from other pre-med human science(biology) majors that are in med school now, nursing science provides you with a fundamental, practical knowledge of the basic sciences, whereas medical school sciences go into MUCH greater depth. In class, the professor would talk about a certain topic, but we wouldn't go too much into WHY something is the way it is. As far as midlevel practitioners go, they do have a more advanced knowledge of the basic sciences, however it still is not to the degree experienced by medical students. The way I see it is each profession has enough knowledge to carry out their job. To put it another way, as an EMT, you might give glucose to a patient, however the EMT-B course doesn't explain how giving glucose works, the process of glycolysis, where the glucose goes, glycogen, how insulin works in the body, etc. EMT-Bs, nurses, midlevels, and doctors understand biological processes at different levels.

 

[foreverLaur]

I don't think thats what he was really saying. I'm pre-med, and my major includes all nursing basic science courses (anat/phys, patho, pharm, microbio). From what I've experienced, and from what I've heard from other pre-med human science(biology) majors that are in med school now, nursing science provides you with a fundamental, practical knowledge of the basic sciences, whereas medical school sciences go into MUCH greater depth. In class, the professor would talk about a certain topic, but we wouldn't go too much into WHY something is the way it is. As far as midlevel practitioners go, they do have a more advanced knowledge of the basic sciences, however it still is not to the degree experienced by medical students. The way I see it is each profession has enough knowledge to carry out their job. To put it another way, as an EMT, you might give glucose to a patient, however the EMT-B course doesn't explain how giving glucose works, the process of glycolysis, where the glucose goes, glycogen, how insulin works in the body, etc. EMT-Bs, nurses, midlevels, and doctors understand biological processes at different levels.

I was a microbiology major for three years so I'm very aware of what the pre-med courses teach. Additionally, you forgot about physician assistants who are taught under the medical model. At least at the school I am interested in, many of the PAs take their first year courses with the first year medical students and most do their second year rotations with the third year medical students.

 

[JRJ26]

I was a microbiology major for three years so I'm very aware of what the pre-med courses teach. Additionally, you forgot about physician assistants who are taught under the medical model. At least at the school I am interested in, many of the PAs take their first year courses with the first year medical students and most do their second year rotations with the third year medical students.

I was actually referring to the nursing science courses, not the pre-med courses. I usually dismiss the pre-med courses in these discussions b/c they have nothing to do with clinical science and you learn everything you need to know to be a doctor or PA or NP, etc. in NP/PA/BSN/MD school. As far as PAs, yes they are taught in the medical model, however as said, the depth to which they go into the basic sciences is not to the degree of MD/DO schools. At some schools they will take some of the basic sciences with MD students, however definitely not all of them. It is not possible to complete all of the MD/DO basic sciences and clinical rotations in two years. So, it is the amount of depth in both cases that is different. Does this make MD/DOs better than NP/PA/DNP/RN/etc? No, it just makes them different, and they all provide different roles in the clinical setting.

 

[foreverLaur]

True - I'm not one of those people who think that PAs/NPs should be equals with physicians. I do think that they are a very valuable asset to the healthcare team however. For example, it allows doctors to see more patients while letting someone else to do the indepth talking with the patients, explaining their meds, treatment plans, etc.

At least at the school I have looked into the most, the PAs essentially do two years of medical school (first and third). I think that stems off of the PA to MD/DO bridge proposal?

 

[All4MyDaughter]

The purpose of this forum is to allow current mid-level providers who are considering a transition to a doctoral level health program to discuss that process.

This thread is off-topic for this forum and has become a farce of ego and one-upmanship. Since you guys have decided to ignore my in thread warning about bickering and bashing other professions, I'm going to go ahead and close it.